WOMENâ€™S HEALTH What every woman should know
Information for Federal Employee Program members only, p. 25
Putting members ﬁrst All About the BlueCard® Program Information for members living and traveling outside of Arkansas
he concept behind the BlueCard program is simple … peace of mind that your health-care needs will be met when you are traveling or living outside of Arkansas and your health plan is with Arkansas Blue Cross and Blue Shield, BlueAdvantage Administrators of Arkansas or Health Advantage. When you are an Arkansas Blue Cross, BlueAdvantage or Health Advantage member, your beneﬁts travel with you wherever you go, both in the United States and around the world. BlueCard gives you the peace of mind of knowing you will have access to in-network doctors and hospitals virtually everywhere you go. Locating an in-network doctor or hospital is easy. You can access this information by Web or by telephone using the following information. • Visit www.BCBS.com, and click on “BlueCard Doctor and Hospital Finder.” • Call 1-800-810-BLUE (2583), and follow the instructions provided. Here’s how it works. If you are a member of Arkansas Blue Cross, BlueAdvantage or Health Advantage and traveling or living out of state, Arkansas is considered your “home” Plan. When you are traveling or living in another state, the Blue Cross Plan in the other state is your “host” Plan. Arkansas, as your home Plan, always will be responsible for the “member relationship.” The host Plan manages the “provider relationship.” For example, an Arkansas Blue Cross member goes on vacation to Florida. While lounging on his raft in the waters of the Gulf Coast, the member gets stung by a jellyﬁsh. The member calls 1-800-810BLUE (2583), gets the name of the nearest participating hospital, and goes to the emergency room. That claim now is considered a “host” claim. The provider (hospital) ﬁles the claim with the Florida
Plan, and the Florida Plan puts the claim into their system and applies their negotiated discounts or fee schedule to the claim. The claim would then be sent to the “home” Plan — Arkansas Blue Cross — and Arkansas Blue Cross would apply beneﬁts to the claim (e.g., coinsurance, deductibles, etc.). Arkansas Blue Cross would advise the Florida Plan how much to pay, according to the beneﬁt plan of the member. The Florida Plan or “host” Plan would actually give the provider a check for the services, but the check would be funded by the “home” Plan — Arkansas Blue Cross. Basically, when members travel or live out of state, they can take advantage of the provider relationships in other states because he or she is a Blue Plan member. And, when Blue Plan members travel to Arkansas and need medical care, they can take advantage of our negotiated rates with providers and our provider networks. By using BlueCard participating providers, members will reduce their out-of-pocket expenses and will not receive “balance billing” from participating providers for covered services. After a member has received care, in most cases, the member should: 1. Not have to ﬁle any claim forms. 2. Not have to pay up front for medical services except for the usual out-of-pocket expenses (noncovered services, deductible, copayment and coinsurance). 3. Receive an Explanation of Beneﬁts (EOB) from your Arkansas Blue Cross, BlueAdvantage or Health Advantage home plan.
Tips for using the BlueCard program 1. Always carry your most current health insurance ID card. 2. When you arrive at the doctor’s ofﬁce or hospital, present your ID card, and the doctor’s ofﬁce or hospital will verify your membership and coverage.
Blue Card Program Quick Q and A Q. Where do I go to receive medical care if I am traveling or living outside of Arkansas (my home Blue Plan service area)? A. If it’s an emergency, go directly to the nearest hospital. To ﬁnd a doctor or hospital in the area where you are traveling or living, call 1-800-810-BLUE (2583). Q. What do I pay for services? A. The beneﬁts under your Arkansas Blue Cross, BlueAdvantage or Health Advantage home Plan will be applied. For example, if BlueCard, continued on Page 15
Blue & You Spring 2006
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health-care professionals and other persons interested in health care and wellness. Vice President, Communications and Product Development: Karen Raley Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Chip Bayer, Janice Drennan, Damona Fisher, Kathy Luzietti and Mark Morehead
Customer Service Numbers Category
Little Rock Number (501)
State/Public School Employees
Arkansas Blue Cross and Blue Shield health insurance plans for individuals and families 378-2010
Arkansas Blue Cross Group Services 378-3070
Federal Employee Program (FEP)
BlueAdvantage Administrators of Arkansas
Pharmacy Customer Service: Arkansas Blue Cross Health Advantage BlueAdvantage Specialty Rx Medi-Pak (Medicare supplement)
1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779 378-3062
Medi-Pak Rx Membership
Medi-Pak Rx Claims
Medicare (for beneﬁciaries only):
For information about obtaining coverage, call: Category
Little Rock Number (501)
Medi-Pak (Medicare supplement)
Health insurance plans for individuals and families
this issue Spring 2006 2 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 24 25 26 27 28
Regional Ofﬁce locations are: Central, Little Rock; Northeast, Jonesboro; Northwest, Fayetteville; South Central, Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana; and West Central, Fort Smith. Customers who live in these regions may contact the regional ofﬁces or call the appropriate toll-free telephone numbers above.
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Blue Comes Through Healthy is beautiful Stress: More than a mere inconvenience Women and heart disease Practice good breast health habits The silent killer: Ovarian cancer Into the light: Treating and beating depression Are you depressed? Look for the signs. Migraines: Identifying “triggers” Coping with the inevitable … Menopause Understanding Lupus A healthy lifestyle can prevent Osteoporosis More women have arthritis Too much acetaminophen can cause liver damage The Healthy Weigh! Education Program Pregnant? Don’t forget the folic acid! Special Delivery added beneﬁt for expectant mothers Secure in Blue BLUEINFO: Three tools to get the info you need Select Quality Care offers new features Ask the Pharmacist How is my health information protected? Notice of privacy practices Blue & You Foundation issues call for grant applications Federal Employee Program member information New choices offered through HSAs and The Vanguard Group Blue & You readers value magazine and Internet services Multi-source Ortho products no longer covered Getting divorced? Coverage information for the Aerochamber “One Class at a Time” grants continue to help teachers Blue & You is archived! New associate medical director: Richard Leithiser, M.D., M.M.M. Arkansas Blue Cross announces leadership changes Blue & Your Community Blue Online
www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
Blue & You Spring 2006
Healthy is beautiful T
oo many women, especially young women and even preteens, suffer from a negative body image. Americans are bombarded with images of perfect women on magazine covers, billboards, television and in movies. They don’t see the heavy makeup, cosmetic surgery, hours of personal training, wardrobe coaching and retouching of photographs that make that image of perfection possible. As a result, too many women experience low self-esteem, anxiety, depression and eating disorders because they feel they can never measure up to the cultural ideal. Today’s woman needs to be smarter about beauty and self-image and realize that healthy is beautiful, no matter what shape, age, color or complexion packages it. Most women can achieve the beauty of health by eating the right foods (not dieting), staying active, getting regular checkups and screenings, avoiding harmful behavior, and focusing on inner strengths and talents and what they have to offer others.
Make a habit of healthy eating
Most women can achieve the beauty of health by eating the right foods, staying active, getting regular checkups and screenings, avoiding harmful behavior, and focusing on inner strengths and talents and what they have to offer others. Blue & You Spring 2006
Healthy eating is a lifestyle choice. It may be hard to get started on that path; but the longer you stick with that decision to eat healthy foods every day, the easier it gets. The more you eat healthier foods, the better you will like them. You’ll ﬁnd they taste better and curb your appetite longer. When you shop for groceries, don’t buy junk food. You know what it is — potato chips, sugar-loaded soft drinks, sweet treats. Remember two words, and you’ll get your shopping list right — fruits and vegetables. That recommended quota of at least ﬁve a day is not an option for healthy living. It’s required. You also should include foods from the other food groups: dairy (milk, yogurt, cheese); protein (meat, poultry, ﬁsh, dry beans, eggs and nuts); grains (bread, cereal, pasta, rice, whole grains for ﬁber); and sparingly, the other stuff (fats, oils, sweets). Remember that fruits and vegetables are their own separate groups in the U.S. Department of Agriculture’s (USDA) new food guide pyramid; and the recommended servings now total ﬁve to nine. Learn to read food labels. You should know that “low fat” or “nonfat” is better than “saturated fat” or “cholesterol” and that “trans fatty acids” are not good for anyone. Less than 10 percent of your daily calories should come from saturated fat and less than 30 percent from total fat. You need to compare the amount of sugar and salt in similar products, such as canned goods, and choose the healthier option. If a nonfat product is high in sugar or salt, it’s probably not a good choice. A woman with a family has a double challenge. She has to select foods that her husband and children will accept, and sometimes that’s not easy. Gradually introducing healthier choices into meals and snacks might be the way to start a family on the road to healthy eating. If your family likes whole milk, gradually wean them to 2 percent and then to nonfat. If they like fried foods, gradually introduce more baked, broiled and grilled foods. Serve parfaits layered with nonfat yogurt, fruit and granola rather than ice cream for a snack. Replace chips with carrot sticks. Working women should stay away from the doughnuts and other goodies their co-workers bring to the ofﬁce. An occasional treat is OK, but a sweet snack at every break is not. Recruit a buddy to help you resist temptation and share your lunch break. Prepare your own healthy meals to bring to work, or go to restaurants that offer healthy choices. Don’t eat at your desk or out of the snack machine.
Make the right choices
Get up; get moving. It’s that simple. You will feel better and live longer if you do; if you don’t, you will age faster and develop more health problems. Like eating healthy, staying active is a lifestyle choice. If you’re not already leading an active life, it can be difﬁcult to get started. The good news is that as little as 30 minutes per day of moderate physical activity most days of the week can greatly improve your health. You don’t have to run the marathon or climb Mount Everest. Start small with an activity you already enjoy, such as walking (even browsing the mall is better than watching TV), gardening, hiking scenic trails or playing badminton with your children, friends, a spouse or signiﬁcant other. Gradually increase the time and intensity of your physical activity. If you are new to physical activity or have chronic health problems, check with your doctor before beginning any exercise program. It’s not about losing weight. It’s about being healthy. If you are overweight, even moderate physical activity combined with healthy eating will lead to gradual weight loss. If you’re thin, an active lifestyle will tone your body and improve your muscle strength and ﬂexibility. The U.S. Department of Health and Human Services lists these beneﬁts of an active lifestyle: • Reduces your risk of dying from heart disease or stroke; • Lowers your risk of getting heart disease, stroke, high blood pressure, colon cancer and diabetes; • Lowers high blood pressure; • Helps keep your bones, muscles and joints healthy; • Reduces anxiety and depression and improves your mood; • Helps you handle stress; • Helps control your weight; • Protects against falling and bone fractures in older adults; • May help protect against breast cancer; • Helps control joint swelling and pain from arthritis; • Gives you more energy; • Helps you sleep better; • Helps you look better.
One of the best choices you can make for a healthy lifestyle is not to smoke. The dangers to health far outweigh any glamour that smoking once had. If you drink alcoholic beverages, limit your intake to one serving per day. A standard drink is one 12-ounce beer, one 5-ounce glass of wine, or one 1.5-ounce shot of distilled spirits. Each of these drinks contains about half an ounce of alcohol. If you have a drug or alcohol abuse problem, seek help. Start by asking your family physician about your options. Use common sense when it comes to personal safety. Always wear a seat belt. Don’t put yourself in situations where you could become a victim of crime. Stay in well-traveled, well-lit areas when you are alone. Have a plan for emergencies. Today’s woman is usually a busy woman, taking care of children, husbands or parents, keeping up with housework and laundry, balancing the checkbook, and often holding a full-time job. Make time for number one. Get regular checkups and recommended screenings, such as mammograms and pap smears. Get a ﬂu shot each year; and wash your hands often. Prevent bone loss by getting enough calcium and vitamin D, especially if you are past menopause, when bone loss accelerates. Getting regular exercise, not smoking and avoiding excessive alcohol intake help prevent bone loss. Occasionally treat yourself to time alone doing something you really enjoy. If you can’t get away from home, take a long, relaxing bath. Use bath salts, bubbles, candles or soothing music to create an escape from everyday tasks. Go for a long walk. Call an old friend just to chat. After taking care of yourself, do what you can to help others. Family demands may be all you can handle. If you ﬁnd some spare time, volunteer at a nursing home or day-care center, or visit an elderly neighbor who would just like to talk to someone. Your sense of self-worth will grow. Your healthy lifestyle will make you feel better, look better and have a more positive mental outlook. That’s the kind of beauty you can’t get on Madison Avenue. ❊ Sources: National Women’s Health Information Center, U.S. Department of Health and Human Services and the National Center for Chronic Disease Prevention and Health Blue & You Spring 2006
Stress: More than a mere inconvenience S
imply stated, stress is your body’s response to change. It is a response that varies greatly from person to person. An event that one person ﬁnds extremely stressful might be a source of relaxation for another. For example, some people ﬁnd large crowds stressful while others enjoy “people watching.” Driving along a mountain road is a white-knuckle experience for some and almost therapeutic for others. Contrary to popular belief, all stress is not bad. Participating in sporting events, speaking to large crowds and rock climbing are all stressful events but can be enjoyable at the same time. There also is more than one kind of stress. According to the American Psychological Association, stress is categorized three ways: 1. Acute Stress – This is the stress that comes from situations in the recent past and anticipation of problems in the near future. A good example would be a short trip on a roller coaster. It is enjoyable in short bursts, but prolonged exposure can lead to physical symptoms like headaches and an upset stomach. Acute stress is the most common kind of stress. 2. Episodic Acute Stress – This is an extended version of acute stress. It is characterized by the experience of going from one
crisis to the next or by moving quickly from project to project. People experiencing episodic acute stress are frequently described as “having too many irons in the ﬁre” or “being in a rush.” 3. Chronic Stress – This is the daily stress that constantly weighs on a person. Living in an unhappy marriage or working in a nonsatisfying job are common sources of chronic stress. Many people are familiar with the common symptoms of stress: anger, fear, a sense of helplessness, trouble sleeping and aches in the neck, head, jaw and back. It contributes to unhealthy habits like smoking, drinking, overeating and drug abuse. What people may not know is that stress may not exhibit any of these symptoms. Instead it may go unnoticed for years. However, it can still contribute to real physical conditions and diseases. Stress has been linked to overall poor health, heart attacks, strokes, and, some scientists suspect, even cancer. The important thing to remember is that our response to situations, not the actual situations, determine the effect stress has on us. Ways to deal with stress include: regular exercise, eating a well-balanced diet, getting plenty of sleep, preparing ahead of time for events you know will be stressful, meditation and “getting away from it all” once in a while. Stress is inevitable, but it can be effectively managed with just a few, practical lifestyle changes. ❊ Sources: American Heart Association and the National Institutes of Health
Blue & You Spring 2006
Women and heart disease It’s not for men only.
oronary heart disease, which is the cause of heart attack, is the leading cause of death for women in the United States. Almost twice as many American women die of heart disease (and stroke) as from all forms of cancer combined … including breast cancer.
What are the risk factors you can’t control? • Increasing age — As women age, their risk of heart disease and stroke also increases. • Gender — Men have a greater risk of heart attack, but each year 40,000 more women than men have a stroke. • Family history — Both men and women are more likely to develop heart disease or stroke if close blood relatives have had them. Also, black women have a greater risk of heart disease and stroke than white women. • Previous heart attack or stroke — Women who have had a heart attack are at a higher risk of having a second heart attack, and 14 percent of those who have survived a stroke or heart attack will have another one within a year.
What are the risk factors you can control? • Smoking — Smoking is a major cause of heart disease among women. Women smokers who use birth control pills have a higher risk of heart attack and stroke than nonsmokers who use them. • High blood cholesterol — Studies have shown that women’s cholesterol levels are higher than men’s after age 45.
• High blood pressure — Women have an increased risk of developing high blood pressure if they are obese, have a family history or high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause. • Physical inactivity — Studies have shown that heart disease is almost twice as likely to develop in those who are inactive compared to those who lead active lifestyles. • Obesity and overweight — Excess weight can lead to high cholesterol levels, high blood pressure, high blood cholesterol, diabetes and increased risk of heart disease and stroke.
What is a heart attack?
• • • • • •
Heart attacks result from blood vessel disease in the heart. A heart attack occurs when the blood supply to part of the heart muscle itself is severely reduced or stopped. If the blood supply is cut off severely or for a long time, muscle cells suffer irreversible injury and die. Disability or death may result. But heart attacks may be stopped in progress and muscle damage reduced if they’re treated within a few (usually one to three) hours. To reduce your risk of a heart attack, remember the following: Do not start smoking. If you smoke, quit. Recognize and treat high blood pressure and diabetes. Don’t drink too much alcohol. Be physically active. Eat a healthy diet. Have regular medical checkups.
Sources: American Heart Association and the National Heart, Blood and Lung Institute
Blue & You Spring 2006
Practice good breast health habits A
lthough occasionally found in men, the two primary risk factors for developing breast cancer are being female and getting older — not exactly factors that can be controlled. While there is no cure at this time, practicing good breast health habits is a woman’s best assurance of detecting and beating this disease. Breast cancer is the leading cause of death in women ages 40-59. A three-step approach to breast cancer screening is recommended for early detection and intervention that includes (depending on a woman’s age) a combination of mammography, clinical breast exams and breast self-exams. • Annual mammograms beginning at age 40 (recommended by leading experts: the National Cancer Institute, the American Cancer Society, and the American College of Radiology) • Clinical breast exam at least every three years beginning at age 20 and annually from age 40. • Monthly breast self-exam beginning by age 20. Women with a family history of breast cancer or other concerns about their personal risk should consult with a health-care provider. Screening tests may need to be done more often and/or started earlier than usual. As part of a total approach to breast health, women should become familiar with own bodies, play an active role in their health, and develop a close partnership with their healthcare providers.
Mammograms Mammography is a technique that uses X-rays to provide an image of the breast. These images, called mammograms, are used to ﬁnd potential signs of breast cancer: tumors, small clusters of calcium (microcalciﬁcations) and abnormal changes in the skin. Overall, mammography is the best screening tool available today for breast cancer. It can ﬁnd cancers at an early stage, when they are small and most responsive to treatment. Mammograms don’t prevent breast cancer, but they can save lives by ﬁnding breast cancer as early as possible. For example, mammograms have been shown to lower the chance of dying from breast cancer by 35 percent in women above the age of 50; studies suggest women between 40 and 50 may lower the chance of dying from breast cancer by 25–35 percent. Finding breast cancers early with mammography also has meant that many more women being treated for breast cancer are able to keep their breasts. When caught early, localized cancers can be removed without resorting to breast removal (mastectomy). Mammograms aren’t perfect. Normal breast tissue can hide a breast cancer so that it doesn’t show up on the mammogram. This is called a false negative. And mammography can identify an abnormality that looks like a cancer, but turns out to be normal. This “false alarm” is called a false positive. To make up for these limitations, more than mammography is needed.
Blue & You Spring 2006
Clinical breast exams Clinical breast exams are physical examinations by physicians, nurse practitioners and other trained medical staff. The exams involve checking the look and feel of the breasts and underarm for any changes. The breasts are checked while a woman is sitting up and lying down. Although often overshadowed by the promotion of regular mammograms, clinical breast exams are an important part of breast cancer screening and should be thought of as a complementary technique to mammography. It is important that women ask for a clinical breast exam if one is not automatically offered. While it’s true that most lumps are found by women themselves, a breast exam by a doctor helps ﬁnd lumps that women may miss. Sometimes, the abnormality in a breast can be so difﬁcult to feel that only someone with experience would recognize it. Lumps, thickening, asymmetry — changes in your breasts that you may not notice or think are “normal” — may be recognized by people who examine many breasts regularly.
Breast self-exam Breast self-exam is a screening method that is intended to ﬁnd early tumors, particularly those that develop in the time between annual mammograms and clinical breast exams. By doing breast self-exams once a month, women can become familiar with the way their breasts look and feel normally and thus may be able to recognize changes, such as thickening, lumps, and spontaneous nipple discharge or skin changes, such as dimpling or puckering. When doing breast self-exams, many women may ﬁnd that their breasts feel lumpy because breast tissue naturally has a bumpy texture. For some women, the lumpiness is more pronounced. In most cases, this lumpiness is no cause to worry. If the lumpiness can be felt throughout the breast, then it is probably just the normal breast tissue. The kinds of lumps that are of concern are ones that are ﬁrmer than the rest of the breast. When such a lump is found, there is more of a risk that it may be cancer, although cysts and ﬁbroadenomas can cause similar lumps. It is not unusual for lumps to appear at certain times of the month but then disappear as your body changes with the menstrual cycle. Only changes that last beyond one full cycle or seem to get bigger or more prominent in some way need your doctor’s attention. Any time a woman discovers a new lump that feels different from the rest of the breast or one that is different from what she has felt before, she should have it checked by a health-care provider. Always bring the area of concern to the attention of your doctor; don’t leave it for a professional to “ﬁnd.”
Early detection The earlier breast cancer is found, the better the chances that treatment will work. The goal is to ﬁnd cancers before they start to cause symptoms. The size of a breast cancer and how far it has spread are the most important factors in predicting the outlook for
The silent killer:
t is the ﬁfth leading cause of cancer death in women, and the No. 1 leading cause of death from gynecologic cancers — yet it is fairly uncommon. Some have called it the “silent killer” because it may go undetected until it is in its advanced stages. About 1 in every 57 women in the United States will develop ovarian cancer. Most cases occur in women above the age of 50, but this disease also can affect younger women. Ovarian cancer is a malignant tumor (cancer) that begins in the ovaries (a pair of organs in the female reproductive system). The exact cause of ovarian cancer is a mystery. However, studies have discovered that the following factors may increase the chances of developing this disease: • Family history — If the mother, daughter or sister of a woman has had ovarian cancer, it increases her risk. • Age — The chances of getting ovarian cancer increase as a woman ages. • Childbearing — Women who have never had children are more likely to develop ovarian cancer than women who have had children. • Personal history — Women who have had breast or colon cancer run a greater risk of developing ovarian cancer than women who have not had breast or colon cancer. • Fertility drugs — Women who have taken drugs to cause ovulation may have a slightly greater risk of developing ovarian cancer than women who have not taken fertility drugs. • Talc — Some studies have suggested that women who have used talcum powder in the genital area for many years may have an increased risk of developing ovarian cancer. • Hormone replacement therapy — There is some evidence to suggest that women who use hormone replacement therapy drugs may have a slightly increased risk of developing ovarian cancer. Studies have suggested that breastfeeding, taking oral contraceptives, or having a tubal ligation or hysterectomy may decrease a woman’s chances of developing ovarian cancer. These factors decrease ovulation, and studies suggest that reducing the number of times a woman ovulates in her lifetime may lower her risk of ovarian cancer. Studies also have suggested that reducing Ovarian cancer, continued on Page 18
Breast health, continued on Page 18 Blue & You Spring 2006
Into the light: Women experience depression almost twice as often as men. after childbirth. All the changes, both hormonal and physical, as well as the added responsibility of caring for a new baby, can contribute to postpartum depression in some women. While the “baby blues” are common in new mothers, an ongoing and “full-blown” depressive episode is not a normal occurrence and requires intervention and treatment. Care from a physician and the support of her family are important to helping a new mother recover from depression and learn to enjoy and care for her new baby.
Types of depression
eeling “down in the dumps” or having the occasional “blues” is normal. Everyone wakes up on the wrong side of the bed once in a while or feels a little overwhelmed by the responsibilities of her life. However, it’s not normal, nor is it a sign of personal weakness, to have prolonged feelings of hopelessness or sadness. A depressive illness is not the same thing as feeling down once in awhile, and it will not just go away. Depression is an illness that requires treatment, and appropriate treatment can help people who suffer from a depressive illness. Approximately 19 million Americans have depression. It can happen to anyone, no matter your age, gender or ethnicity. However, women experience depression almost twice as often as men. Hormonal factors may contribute to the increased rate in women — especially such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause and menopause. Many women also face additional stresses from responsibilities in their lives stemming from both work and home, including caring for children and aging parents. Many women also are particularly susceptible to depression
Blue & You Spring 2006
Major depression — Interferes with the ability to work, study, sleep, eat and enjoy once pleasurable activities. Dysthymia — Less severe than major depression; involves long-term, chronic symptoms that do not disable but interfere with the ability to function well or feel good. Bipolar disorder (manic-depressive illness) — Characterized by cycling mood swings: severe highs and lows.
Symptoms of depression • • • • • • • • • • •
Persistent sad, anxious or empty mood Feelings of hopelessness and pessimism Feelings of guilt, worthlessness and helplessness Loss of interest or pleasure in hobbies and activities that were once enjoyed Decreased energy, fatigue Difﬁculty in concentrating, remembering and making decisions Insomnia or oversleeping Loss of appetite or overeating Thoughts of death and suicide; suicide attempts Restlessness; irritability Persistent medical conditions that do not respond to treatment, such as headaches, digestive disorders and chronic pain
Treating and beating depression Hormonal factors may contribute to the increased rate of depression in women. Causes of depression Some types of depression run in families, suggesting a biological vulnerability. In some families, depression seems to occur generation after generation. However, it also can occur in people who have no family history of depression. People with low selfesteem or who are overwhelmed by stress are prone to depression. In recent years, researchers have found that physical illness may be accompanied by mental changes as well. Medical illnesses such as stroke, heart attack, cancer, Parkinson’s disease and hormonal disorders can cause depressive illness. Usually, a combination of genetic, psychological and environmental factors may lead to the onset of a depressive illness.
Treatment for depression There are four steps to getting help for depression: 1) Look for signs of depression; 2) Understand that depression is a real illness; 3) See your doctor to get a checkup and talk about how you are feeling; and 4) Get treatment for depression. If you think you are suffering from depression, see your doctor. You need to have a medical checkup to rule out other illnesses that may be causing signs of depression. There are two common types of treatment for depression: talk therapy and prescription medication. Some people need both types of treatment to feel better. Talk therapy involves talking to someone such as a psychologist, social worker or counselor. The medications for depression are called “antidepressants,” and they may take a few weeks to work. Sometimes medications cause side effects, such as feeling tired or having blurred vision. Talk to your doctor if you experience side effects from antidepressants. With treatment and support from family and friends, someone suffering from a depressive illness can feel better. ❊ Sources: National Institute of Mental Health and the National Women’s Health Information Center
Are you depressed? Look for the signs. Put a check mark by each sign that sounds like you. ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏
I am really sad most of the time. I don’t enjoy doing the things I’ve always enjoyed doing. I don’t sleep well at night and am very restless. I am always tired. I ﬁnd it hard to get out of bed. I don’t feel like eating much. I feel like eating all the time. I have lots of aches and pains that don’t go away. I have little to no sexual energy. I ﬁnd it hard to focus and am very forgetful. I am mad at everybody and everything. I feel upset and fearful but can’t ﬁgure out why. I don’t feel like talking to people. I feel like there isn’t much point to living; nothing good is going to happen to me. ❏ I don’t like myself very much. I feel bad most of the time. ❏ I think about death a lot. I even think about how I might kill myself. If you checked several boxes, call your doctor. You may need to get a checkup to ﬁnd out if you have depression. ❊ Source: National Institute of Mental Health
Blue & You Spring 2006
Migraines: Identifying “triggers” may help prevent frequent headaches
f you have seen ﬂashing lights or experience temporary loss of vision prior to developing a painful migraine headache, you know the true meaning of dread. Those warning signs are a signal to many people that they are about feel very, very bad. Approximately 20 to 30 percent of those who suffer with migraines have “migraine with aura,” which also is known as a “classic” migraine. Others who suffer migraines have “migraines without aura,” which are known as “common” migraines. The aura is a physiological warning that a migraine is about to begin. Visual auras include bright ﬂashing dots or lights, blind spots, distorted vision, temporary vision loss and wavy or jagged lines. The National Headache Foundation estimates that 28 million Americans suffer from migraines, and more women get migraines than men. Each migraine can last from four hours to three days. Nausea, vomiting and sensitivity to light often accompany the painful headaches. No one knows what exactly causes migraine headaches. People with migraines often inherit the tendency to be affected by certain migraine triggers. Migraines usually run in families, and four out of ﬁve migraine sufferers have a family history of migraines. Many migraines are triggered by external factors including
emotional stress; sensitivity to speciﬁc chemicals and preservatives in foods; caffeine; changing weather conditions; menstrual periods; excessive fatigue; skipping meals; and changes in normal sleep patterns. Symptoms of migraines include a pounding or throbbing headache; sensitivity to light and noise; nausea and vomiting; loss of appetite; paleness, fatigue and dizziness; blurred vision; diarrhea; and, rarely, fever. Unfortunately, there is no cure for migraine headaches. However, there are many medications (including over-the-counter and prescription medications) that can be used to treat migraines. Talk to your doctor about what method of treatment is best for you. You can reduce the frequency of migraine headaches by identifying and then avoiding the migraine triggers. With a diary, try to keep track of your headache patterns and identify headache triggers. One of the best ways to reduce the number of migraines is to live a healthy lifestyle — eat right, get plenty of rest and get regular exercise. ❊ Source: MedlinePlus
Coping with the inevitable …
hether it’s a headache or a hot ﬂash, some women may experience uncomfortable symptoms when faced with the inevitable condition that comes with age — menopause. Menopause is a normal condition that all women face as they age (usually between the ages of 45 and 55) … and marks the end of the reproductive period of their lives. After menopause is complete, pregnancy is no longer possible. Common symptoms of menopause include irregular or missed periods, insomnia, mood swings, fatigue, depression, irritability, racing heart, headaches, joint/muscle aches, vaginal dryness and bladder control problems. Health problems associated with menopause include osteoporosis (see related article on Page 13) and heart disease (see related article on Page 7). Both conditions have been associated with the loss of estrogen.
Treatments for the symptoms of menopause are available. Please consult your doctor to determine what treatment option is best for you. You can reduce your risk of long-term problems such as osteoporosis and heart disease by using the following guidelines: • Do not smoke; cigarette smoking can cause early menopause. • Exercise regularly to strengthen your bones. • Take calcium and vitamin D. • Eat a low-fat diet. • Control your blood pressure, cholesterol and other risk factors for heart disease. ❊ Source: MedlinePlus
Blue & You Spring 2006
A healthy lifestyle can help prevent
lthough anyone can get lupus, it most often affects women. It is a disease with an unknown cause, but it is likely that there are many factors that lead to the disease. The immune system protects the body by attacking unknown substances in the body. With lupus, something is wrong with the immune system, and it preys on healthy cells and tissues. This can damage the joints, skin, kidneys, heart, lungs, blood vessels and brain. There are many types of lupus, but systemic lupus erythematosus is the most common and affects many parts of the body. Symptoms of lupus include: • Pain or swelling in joints • Muscle pain • Fever with unknown cause • Red rashes, most often on the face • Chest pain when taking a deep breath • Hair loss • Pale or purple ﬁngers or toes • Sensitivity to the sun • Swelling in legs or around eyes • Mouth ulcers • Swollen glands • Feeling tired If you have been diagnosed with lupus, your doctor can create a treatment plan to ﬁt your needs. The goal of the treatment plan is to prevent ﬂare-ups, treat ﬂareups as they occur and reduce organ damage and other problems. The treatment plan may include medication.
❊ Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
pproximately eight million women and two million men in the United States have osteoporosis. Additionally, 34 million Americans are estimated to have low bone mass, putting them at risk for osteoporosis. Osteoporosis is the progressive loss of bone density and thinning of bone tissue. The leading cause of osteoporosis is hormone deﬁciencies, so women who are menopausal may be at risk. Signiﬁcant risk of osteoporosis has been reported in people of all ethnic backgrounds. Although it is often reported as an older person’s disease, it can strike at any age. In addition to being menopausal, other risk factors include: • Personal history of fracture after age 50 • Current low bone mass • History of fracture in close female relative • Being female • Being thin and/or having small frame • Advanced age • A family history of osteoporosis • Abnormal absence of menstrual periods • Anorexia nervosa • Low lifetime calcium intake • Vitamin D deﬁciency • Use of certain medications (i.e., corticosteroids, chemotherapy, etc.) • Low testosterone levels in men • An inactive lifestyle • Current cigarette smoking • Excessive use of alcohol There are no symptoms of osteoporosis in its earliest stages. However, symptoms occurring late in the disease include: fractures of the vertebrae, wrists or hips; low back pain; neck pain; bone pain or tenderness; loss of height over time; and stooped posture. Treatment options should be discussed with your primary care physician. They may include medications (estrogen replacement therapy), lifestyle changes (regular exercise) and a diet that includes calcium, vitamin D and protein. Prevention of this disease is a lifelong commitment. ❊ Source: MedlinePlus
Blue & You Spring 2006
More women have arthritis A
rthritis is the most common and disabling chronic condition in American women. Women are almost twice as likely as men to suffer from arthritis. The disease is more common after age 45, but it is not a disease of the elderly — more than 300,000 children also are affected. If you are feeling a little pain or stiffness in your joints, you may be one of 43 million Americans who have arthritis. Arthritis is one of the most common chronic health conditions and the No. 1 cause of limitation in movement in the United States.
What is arthritis?
Arthritis is the umbrella term for more than 100 different diseases that cause pain, swelling and limited movement in joints and connective tissue throughout the body. It usually is chronic, which means it lasts a lifetime. Anyone at any age may be diagnosed with arthritis. Some forms also can affect other parts of the body, including various internal organs. Many people use the word “arthritis” to refer to all rheumatic diseases. However, the word literally means joint inﬂammation; that is, swelling, redness, heat and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases.
What are the symptoms of arthritis? Symptoms of arthritis are pain, stiffness, swelling (sometimes) and difﬁculty moving a joint. If you notice one or more of these symptoms for more than two weeks, you should make an appointment to see your doctor. Physicians can diagnose arthritis based on an overall pattern of symptoms, medical history, a physician examination, X-rays and laboratory tests. Most treatment programs include a combination of medication, exercise, maintaining an appropriate weight, rest, use of heat and cold, joint protection techniques and, sometimes, surgery. If you are experiencing symptoms of arthritis (or you know someone who is), please seek a diagnosis and treatment from your doctor.
How is arthritis pain treated? There is no single treatment that applies to everyone with arthritis. Your doctor will develop a management plan designed to minimize your speciﬁc pain and improve the function of your joints. A number of treatments can provide short-term pain relief. Examples include: 1. Medications — Because people with osteoarthritis have very little inﬂammation, pain relievers such as acetaminophen (Tylenol*) may be effective. Patients with rheumatoid arthritis generally have pain caused by inﬂammation and often beneﬁt from aspirin or other nonsteroidal anti-inﬂammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil).
Blue & You Spring 2006
2. Heat and cold — The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs. 3. Joint protection — Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your doctor or physical therapist can make recommendations.
What causes arthritis pain? The pain of arthritis may come from different sources. These may include inﬂammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain. For unknown reasons, the pain of arthritis varies greatly from person to person. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint.
What exercise is best for someone with arthritis? Three types of exercise are best for people with arthritis: 1. Range-of-motion exercises (e.g., dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase ﬂexibility. 2. Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. 3. Aerobic or endurance exercises (e.g., bicycle riding) improve cardiovascular ﬁtness, help control weight, and improve overall function. Weight control can be important to people who have arthritis because extra weight puts extra pressure on many joints. Some studies show that aerobic exercise can reduce inﬂammation in some joints. Arthritis affects people in different ways. It’s always best to discuss treatment options, pain management and exercise programs with your physician. ❊ Sources: The Arthritis Foundation®, the National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse and the PDR Family Guide to Prescription Drugs
Too much acetaminophen can cause liver damage A
new study has focused renewed attention on the risk of liver damage and unintentional poisoning as a result of taking too much acetaminophen. Many patients inadvertently are taking high doses of acetaminophen because the drug is contained in so many overthe-counter (OTC) products as well as in prescription narcotics that contain acetaminophen, according to the New York Times. Approximately 200 prescription drugs contain acetaminophen plus an opiate, including hydroconebitartrate plus acetaminophen (Vicodin) and oxycodone hydrochloride plus acetaminophen (Percocet). The study appeared in the December 2005 issue of Hepatology. In the study (conducted between 1998 and 2003), researchers followed 662 patients who had acute liver failure and were treated at 23 U.S. transplant centers. They linked 42 percent of those cases to acetaminophen overuse. During that ﬁve-year period, the annual percentage of acetaminophen-related acute liver failure
rose from 28 percent to 51 percent. Suicide attempts accounted for 44 percent of those cases, while most unintentional cases were among those taking multiple acetaminophen-containing products simultaneously or narcotic-containing compounds. Susceptible patients also had depression, chronic pain and alcohol or narcotic use, according to researchers. The problem of taking too much of the drug via multiple OTC drugs was blamed in part on poor labeling that de-emphasizes acetaminophen risks, according to the New York Times. Generally, adults can safely take four grams of acetaminophen during a 24-hour period, the New York Times reported, but taking up to eight grams can result in serious problems in people who have contracted a virus, taken other medication or consumed alcohol. Swallowing 12 to 15 grams in one dose could be fatal. Source: New York Times (Nov. 29, 2005)
BlueCard, continued from Page 2 your copayment is $100 in Arkansas, it will be $100 no matter where you are visiting or living. Q. How does the claim get ﬁled? A. The host Blue Plan will ﬁle the claim. Q. What telephone number should I call for customer service if I live out of state? And, what number do I call for service when I return to Arkansas? A. Call your home Plan. The Customer Service numbers are: Arkansas Blue Cross 1-800-800-4298 BlueAdvantage 1-888-872-2531 Health Advantage 1-800-843-1329 Wal-Mart service by BlueAdvantage 1-866-823-3790 ALLTEL service by Arkansas Blue Cross 1-866-800-4298 Q. How can I get a prescription ﬁlled when I am traveling or living outside of Arkansas? A. To ﬁnd a participating pharmacy, call the pharmacy telephone number on the back of your ID card. Q. How long will the entire process take? A. The entire process — from the time the claim is ﬁled until it is ﬁnalized and paid — could be from 14 to 24 days. The amount of time also depends on whether the claim is “clean” or if additional information is needed to determine applicable beneﬁts.
Q. Can I visit an out-of-network provider when traveling or living in another area? A. You have the option of using a nonparticipating hospital or doctor, but you may have to pay that provider directly and then ﬁle a claim with Arkansas Blue Cross for reimbursement of covered expenses. Also, a non-participating provider may not accept the Plan’s allowances as payment in full; therefore, you would be responsible for any amount over these allowances. Coverage may vary, so contact Arkansas Blue Cross for details.
Arkansas Blue Cross is at your service Arkansas Blue Cross processed more than two million BlueCard claims in 2005. The majority of those claims went through the process “clean.” If you need more information about the BlueCard Program, visit our Web sites (see Web addresses on Page 3) or call Customer Service: Arkansas Blue Cross 1-800-800-4298 BlueAdvantage 1-888-872-2531 Health Advantage 1-800-843-1329 Wal-Mart service by BlueAdvantage 1-866-823-3790 ALLTEL service by Arkansas Blue Cross 1-866-800-4298 When you are traveling or living outside of Arkansas, we want you to enjoy the peace of mind that comes from being a member of Arkansas Blue Cross, BlueAdvantage or Health Advantage. ❊
Blue & You Spring 2006
The Healthy Weigh! Education Program
any diseases are associated with overweight and obesity. Women who are overweight or obese are at an increased risk for high blood pressure, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some types of cancer. The health outcomes related to these diseases, however, often can be improved through weight loss or, at a minimum, no further weight gain, according to the Department of Health and Human Services (www.4woman.gov). So, are you ready to make a change in your weight? Arkansas Blue Cross and Blue Shield can help! Arkansas Blue Cross offers a Health Education Program called The Healthy Weigh! If you are an Arkansas Blue Cross, Health Advantage, Blue Cross and Blue Shield Service Beneﬁt Plan (Federal Employee Program), or BlueAdvantage Administrators of Arkansas member, you are eligible to participate in The Healthy Weigh! Education Program.
The program is free to those who complete the enclosed enrollment form, and return it in the enclosed self-addressed postage-paid envelope. The information available through this program is based on guidelines set forth by the National Institute of Health Obesity Education Initiative. As a participant in this program, you will receive educational information in the mail including tips, a BMI chart, a list of wellness discounts that are available to you as an Arkansas Blue Cross, Health Advantage, Federal Employee Program or BlueAdvantage member and much more. The program starts when you enroll. To enroll, simply complete, sign and return the enclosed enrollment form in the self-addressed postage-paid envelope included in Blue & You. You will begin to receive information through the mail, which you can read in the privacy of your own home, and at your own pace. The program is completely voluntary, and you may leave the program at any time. If you have further questions about the program, call the Health Education Program’s toll-free number at 1-800-686-2609. ❊
Pregnant or thinking about becoming B
irth defects affect approximately 120,000 newborns in the United States each year; they are the leading cause of infant death and contribute substantially to long-term disability. In 1992, lifetime care for infants born in a single year with any of 17 major birth defects was estimated to cost more than $6 billion. Taking folic acid is one way to help prevent major birth defects of a baby’s brain and spine. Folic acid is a B vitamin. It helps the body make new cells. A woman should have enough folic acid in her body before she is pregnant to help prevent birth defects. Women need to take folic acid every day starting before they become pregnant. Health-care professionals should encourage women of childbearing age to practice healthy behaviors, including taking multivitamins containing folic acid, managing chronic medical conditions, having regular medical examinations, and avoiding alcohol, tobacco and illicit drugs. Every woman who could possibly get pregnant should take 400 micrograms (400 mcg or 0.4 mg) of folic acid daily in a vitamin or in foods that have been enriched with folic acid. There are two simple ways to be sure to get enough each day: Take one vitamin with folic acid each day. Most multivitamins
Blue & You Spring 2006
sold in the United States have the amount of folic acid women need each day. Women also can choose to take a small pill each day that only has folic acid in it. Both types of vitamins can be found at most local pharmacies, or grocery or discount stores. OR Eat a bowl of a breakfast cereal that has 100 percent of the daily value (DV) of folic acid per serving every day. The label on the side of the box should say “100%” next to folic acid. Taking folic acid before and during early pregnancy can prevent serious birth defects of the spine and brain (i.e., neural tube defects). The rates of such birth defects declined 26 percent after folic acid was ﬁrst added to cereal-grain products in 1998 because of a federal mandate. Some of the cereals that contain 100 percent of the daily value of folic acid include:
General Mills • • • •
Multi-Grain Cheerios® Total® Corn Flakes Total® Raisin Bran Total® Whole Grain
added beneﬁt for expectant mothers
he Special Delivery program is a pregnancy program offered as an additional beneﬁt to our members. The program is designed to help our members have healthier pregnancies. It was created with three strategies in mind — education, assessment and intervention — to educate the expectant mother in the prevention of preterm births secondary to high-risk prenatal conditions. The Special Delivery program is available to Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members regardless of their pregnancy-risk status. The program is free to expectant mothers. Once registered, each expectant mom will receive educational material and coupons by mail to encourage good health practices during pregnancy, including materials to increase her awareness of symptoms that may signal preterm labor. The Special Delivery nurse can assist in coordinating coverage of home-health care in lieu of hospitalization for the high-risk patient whose physician feels she would beneﬁt from this alternative care. Through case management, Special Delivery can provide coverage of services that normally are not offered, such as skilled-
nursing assessments and nursing-assistant care in the home for conditions including: pregnancy-induced hypertension, diabetes mellitus and preterm labor.
How To Enroll Expectant mothers should enroll by the 14th week of pregnancy. The expectant mother will complete a risk assessment answering a series of basic questions. The questions are designed to identify factors that may put the mother and/or baby at risk. If risk exists, the expectant mother is followed throughout her pregnancy to determine if home-health care is appropriate. Online enrollment is available through My Blueprint, our member self-service center. For more information, please call 1-800-742-6457 or 210-7032 (Little Rock) or e-mail SpecialDelivery@arkbluecross.com. ❊ NOTE: No member should ever rely on any advice or information from the Special Delivery nurse as a substitute for the advice of her own physician. The Special Delivery program is not a substitute for the health-care services and advice of her physician and does not assume responsibility for her medical care or advice. It is intended solely to provide general education as well as assistance in accessing health-plan beneﬁts related to her pregnancy. You should always consult your own physician and follow his or her advice and direction with respect to all aspects of your or your child’s medical care.
pregnant? Don’t forget the folic acid! Kellogg’s® • • • •
• • • •
All-Bran® Original Complete® Oat Bran Flakes Crispix® Healthy Choice™ — Almond Crunch with Raisins, Low-Fat Granola with Raisins, Low-Fat Granola without Raisins, Mueslix, and Toasted Brown Sugar Squares Product 19® Smart Start® Special K® Malt-O-Meal®
Quaker Oats • Cap’n Crunch Red box®, Cap’n Crunch with Crunch Berries®, Peanut Butter Crunch®, Cinnamon Crunch® • Life Cereal/Cinnamon Life® • Oatmeal Squares® • Quisp® • Sweet Crunch®
• Toasted Oatmeal® (Regular ﬂavor and Honey Nut) • Toasted Oats® Other examples of foods that contain folic acid are: pasta, rice, beans (black, baked, Great Northern and kidney), peanuts, greens (spinach, collards, mustard and turnip), broccoli, okra, orange juice, strawberries, banana, cantaloupe and kiwi. Information on the prevention of birth defects is available from the March of Dimes (www.marchofdimes. com) and the National Birth Defects Prevention Network (www.nbdpn.org). Information also is available from the National Council on Folic Acid (www.folicacidinfo.org). ❊ Sources: Centers for Disease Control and Prevention and Arkansas Department of Health: Division of Nutrition Services
Blue & You Spring 2006
Secure in Blue
Ben Owens (center), president of St. Bernards Healthcare in Jonesboro and Arkansas Blue Cross and Blue Shield board member, recently purchased a BlueSecure policy from Ruth Hagewood (left), a long-term care sales representative, and Bill Brown, regional executive with Arkansas Blue Cross’ Northeast Regional Ofﬁce. BlueSecure is an affordable, long-term care (LTC) insurance policy that can help policyholders protect their assets by helping them plan for long-term care when they need it. Long-term care includes in-home care, assisted living and nursing home care, Alzheimer’s facility or hospice. The need for such care can deplete a lifetime of savings. Providing for it can place a substantial burden on the resources of even the most supportive family. An estimated 40 percent of the 13 million Americans receiving long-term care services are between the ages of 18 and 64.
Breast health, continued from Page 9 a patient. Most doctors feel that early detection for breast cancer saves many thousands of lives each year. While the widespread use of screening mammography has increased the number of breast cancers found before they cause any symptoms, some are still missed.
Symptoms of Breast Cancer The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard and has uneven edges is more likely to be cancer. But some cancers are tender, soft and rounded. So it’s important to have anything unusual checked by your doctor. Other signs of breast cancer include the following: • A swelling of part of the breast • Skin irritation or dimpling Ovarian Cancer, continued from Page 9 the amount of fat in the diet may lower the risk of developing ovarian cancer. A study from the American Cancer Society discovered that risk of death from ovarian cancer is higher in overweight women.
Symptoms There usually are no obvious signs of ovarian cancer until it is in the advanced stages. Symptoms may include: • Abdominal discomfort and/or pain (gas, indigestion, pressure, swelling, bloating, cramps) • Nausea, diarrhea, constipation or frequent urination • Loss of appetite • Feeling of fullness even after a light meal • Weight gain or loss with no known reason • Abnormal bleeding from the vagina
Blue & You Spring 2006
• • • •
Nipple pain or the nipple turning inward Redness or scaliness of the nipple or breast skin A nipple discharge other than breast milk A lump in the underarm area Recognizing the symptoms of breast cancer — often found through practicing the three breast health habits — should lead to quick intervention. Alone, each step is important. Together, these three steps are powerful and offer the best defense women have to protect themselves and to detect breast cancer early enough to have successful outcomes. The sooner a breast-health program is begun and consistently followed, the greater the chances of survival. ❊ Sources: American Cancer Society, Susan G. Komen Breast Cancer Foundation, breastcancer.org
It’s important to note that these symptoms also may be caused by less serious conditions. You should see your doctor about any of these symptoms. Treatment for ovarian cancer may include surgery, chemotherapy or radiation therapy. However, treatment depends on a variety of factors including the stage of the disease and the general health of the patient. After a woman has been treated for ovarian cancer, the followup care is very important. Regular checkups generally include a physical exam as well as a pelvic exam. Living with a serious disease may be overwhelming for the patient. It’s important to seek help coping with the emotional aspects of the disease. It should be part of the treatment plan. Source: National Cancer Institute
BLUEINFO My Blueprint
www.ArkansasBlueCross.com • www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com
It’s easy to register to use My Blueprint, the online customer self-service center for Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members. Visit our Web sites to use My Blueprint. Members can enter their health plan ID number, name, date of birth and Social Security number (SSN). If we have your SSN on ﬁle in our membership system, we can authenticate you and let you choose your own log-in ID and password. You will be able to access health tools immediately. You will receive an activation code via the U.S. Postal Service that will allow access to your personal data, such as medical and pharmacy claims. Remember that any covered person, not just the policyholder or group employee, can register. The Arkansas Blue Cross family of companies is trying to make our Web sites more user-friendly while continuing to protect the privacy of your personal health information.
My BlueLine With My BlueLine, you have access to customer service 24 hours a day, seven days a week. If you are a customer of Arkansas Blue Cross, Health Advantage or BlueAdvantage, you can get answers to your claims or beneﬁts questions anytime, day or night. Call the telephone number on your ID card, or refer to Page 3 for Customer Service telephone numbers. My BlueLine is an interactive voice response (IVR) system that recognizes speech patterns to help answer questions when you call current customer service telephone lines. When you call a customer service line and select My BlueLine, it will prompt you with a question, and all you have to do is simply respond to the question. When you call, remember to have your ID card on hand. For privacy purposes, the system will ask you questions to verify your identity as the caller — such as your member ID number as it is listed on your membership card. If you prefer, you immediately may choose the option of speaking to a customer service representative (during regular business hours).
HealthConnect Blue HealthConnect Blue is a complimentary, conﬁdential health information service that puts members in touch with Health Coaches by telephone or e-mail and offers health information online to help members make more informed decisions about their health care. Currently, all Health Advantage members and eligible Arkansas Blue Cross and Blue Shield members* have access to HealthConnect Blue. Members can call a toll-free telephone number (1-800-318-2384) to speak with a Health Coach to get the support and health information they need 24 hours a day, 7 days a week. Health Coaches are specially trained health professionals such as nurses, respiratory therapists and dietitians. Members may call as often as they like at no cost. A Health Coach can offer information and support to help members work with their doctors to make conﬁdent health decisions that are right for them. Members also can access free health information online by using the HealthConnect Blue link at www.HealthAdvantage-hmo.com or at www.ArkansasBlueCross.com. ❊ * Includes all Health Advantage HMO members and all public school employees and state employees covered by Arkansas Blue Cross or Health Advantage.
BLUEINFO Blue & You Spring 2006
Select Quality Care offers new features
elect Quality Care now provides Arkansas Blue Cross and Blue Shield, Health Advantage, BlueAdvantage Administrators of Arkansas and USAble Administrators members new features to help them play a more active and informed role when a physician recommends surgery or another procedure that requires hospital care. Select Quality Care, introduced in June 2005, is a Web-based, health-care decision tool that provides members a way to review an independent comparison of hospital quality measures by procedure or diagnosis. Select Quality Care offers side-by-side comparisons that are based on evidence-based measures, such as patient volume, mortality rates and unfavorable outcomes. To date, Select Quality Care has allowed members to receive independent comparisons of hospitals in their area by procedure or diagnosis. The information members drew from was based on Medicare data only.
Texas, will be based on the Texas database. Members always are asked to conﬁrm with Customer Service that a selected hospital is within their covered network by calling the telephone number on their member ID card or searching the online provider directory for their in-network hospitals.
Health Plan or Medicare Data
Now members have the choice of selecting data from either health plan information or Medicare information. The health plan data provides diagnoses and procedures, such as deliveries and pediatric surgery, which were absent in the Medicare information alone. Every hospital in every state is required to submit detailed information to the federal government about the Medicare patients they treat (generally over 65 or disabled), for what the patients are treated, and how successful the treatment is. Now, Select Quality Care provides the same detailed information based on health-plan data, which covers a broader array of diagnoses.
Taking into account the importance the member places on each measure, Select Quality Care reports on four hospital measures: 1. Number of Patients Treated: The number of patients refers to those treated for a speciﬁc condition or procedure. No hospital has information included in the selection list unless it has treated more than 10 patients in a year for the speciﬁed diagnosis or procedure. There are some areas of our state where the hospitals will not have enough data to be ranked. This may produce confusion or concern if members navigate the site only to ﬁnd no hospital near them that meets the 10-patient requirement to be ranked. In no way, however, should this imply poor quality. 2. Mortality Rate: The mortality rate is the percentage of patients who died while being treated for a speciﬁc condition or procedure. 3. Complication Rate: The complication rate is the percentage of patients who developed problems while being treated. 4. Length of Stay: Length of stay is the average number of days people stayed in the hospital for treatment of a speciﬁc condition or procedure. “Shorter lengths of stay may indicate more efﬁcient care and perhaps fewer complications,” Dr. Marvin said.
New “Other Evals” Tab In addition, information is enhanced on the site with an “Other Evals” tab that provides 20 new quality of care measures for heart, surgery and pneumonia conditions, as standardized by the Centers for Medicaid and Medicare Services (CMS). Members can ﬁnd summary chart information on these serious medical conditions by searching “Heart Attack,” “Heart Failure,” “Pneumonia” or “Surgery” through the “Other Evals” tab. Hospital care can vary signiﬁcantly; some hospitals provide especially good care for certain conditions. Select Quality Care gives members access to information — number of patients treated, mortality rate, number of complications and length of stay — which they can discuss with their physician when making a choice. Select Quality Care provides information on all hospitals in Arkansas with hospital identiﬁers as to whether they are in-network or out-of-network. The Medicare and health-plan data will be updated annually on the Web sites, and the provider network information will be updated semiannually. For network hospitals located outside of Arkansas, the other state’s database will be used for the hospital-speciﬁc information that is displayed. For example, data on CHRISTUS St. Michael, located in Texarkana,
Blue & You Spring 2006
Hospital Cost Although Select Quality Care does not compare the cost of treatment, cost is usually a consideration when selecting a hospital. Members will have lower out-of-pocket costs when they visit an in-network hospital. A member’s PPO (preferred provider organization) or POS (point of service) health plan may provide out-of-network beneﬁts, but an HMO (health maintenance organization) plan will not. Select Quality Care, continued on Page 21
Ask the Pharmacist P
What is a formulary?
eople who are not involved in medical or pharmacy practice usually do not use the word “formulary,” but its use is becoming more prevalent in major health-care and prescription programs. A formulary is a list of names, substances, formulas or other items that are compiled to become an ofﬁcial or recognized record of covered medications. At Arkansas Blue Cross and Blue Shield, a formulary is a list of approved prescription medications. The formulary usually is a document that changes periodically based on additions or deletions — with the revised versions becoming the ofﬁcial formulary. Hospitals, insurance programs, government programs, the armed forces, and many other high-volume purchasers of medications incorporate a formulary into their pharmacy program to create an ofﬁcial list recognizing medications that are available to members of that particular group. Every formulary will have an ofﬁcial name that links its identity to a particular group. A formulary is the centerpiece of the new Medicare Part D Prescription Drug Program, and the public probably will see this term used more frequently. A drug or medication formulary is speciﬁc. Its primary purpose is to identify a select group of medications. A formulary may be
positive (i.e., the medications listed are covered and available), or it may be a negative formulary (i.e., a list of medications that are not covered or available). With either, the list is ofﬁcial and becomes effective. Formularies should be readily available and clearly understood by members who need to refer to them. The primary purpose of a medication formulary is control. Controlling the use of medications steers members to more effective, safer and less-costly medications. The medication formulary creates a competitive medication marketplace where pharmaceutical companies must focus on reducing costs and prove the value of their product. Properly used, the formulary is a valuable asset to the health-care delivery system; however, it is not perfect. The negative is that having different formularies in a particular area from multiple groups can create confusion for physicians and pharmacists as they try to determine which formulary is applicable for a particular person. The age of the paper formulary is giving way to the electronic formulary that delivers a patient’s formulary information immediately to a physician or pharmacist at the point of service. Determining which medications are to be included or excluded from a formulary is critical. It is important that these decisions are made by an unbiased group and are determined from evidencedbased, scientiﬁc information that has endured critical scrutiny from the major medical and pharmacy disciplines. A pharmacy and therapeutics committee, comprised of carefully selected practicing physicians and pharmacists joined by other uniquely qualiﬁed persons, works to produce and maintain a sound medication formulary. The affordability of pharmaceuticals quickly is becoming a major dilemma for the world economy. A medication formulary is just one of the management instruments available that should allow the continued use of available pharmaceutical therapies. ❊
Select Quality Care, continued from Page 20
How To Use Select Quality Care To use this hospital quality comparison tool, members should visit www.ArkansasBlueCross.com, www.HealthAdvantage-hmo. com or www.BlueAdvantageArkansas.com, and click on the My Blueprint link on the home page. They will see the “Compare Hospital Quality” link on the My Blueprint “Welcome” page after logging in. USAble Administrators members can access the tool by visiting www.USAbleAdmin.com and clicking on the My Tracker link on the home page. They then will log in to the secured member portal before receiving access. To activate either My Blueprint or My Tracker, a member must log on and click on the “First-time User” link, which takes the member to the registration information page. Utilizing the information on their member ID card, the member then completes the registration form.
The use of Select Quality Care is conﬁdential. Neither Arkansas Blue Cross, Health Advantage, BlueAdvantage, USAble Administrators nor WebMD Health, which powers Select Quality Care, knows, collects, records or shares any personal information about members or their use of Select Quality Care. Arkansas Blue Cross, Health Advantage, BlueAdvantage and USAble Administrators recommend that members always ask the advice of their physician on this or any other important healthcare decision. Select Quality Care is provided at no additional cost as a value-added service and is available online 24 hours a day, seven days a week. Members access Select Quality Care through either the secure My Blueprint section or My Tracker section on the companies’ Web sites. ❊
Blue & You Spring 2006
How is my health information protected? How can I be sure?
n April 2003, Arkansas Blue Cross and Blue Shield and Health Advantage implemented processes and procedures to meet the requirements of the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. While compliance is mandated, Arkansas Blue Cross believes that protecting privacy rights is the right thing to do for our members, who expect conﬁdentiality and privacy regarding their medical information and history. “A fundamental component of the overall service commitment we make to our customers is the strict maintenance of their personal information relative to both privacy and conﬁdentiality,” said Robert L. Shoptaw, chief executive ofﬁcer of Arkansas Blue Cross. “This is ‘job No. 1’ for each of us in every area of our operations.” The Privacy Rule created national standards to safeguard individuals’ protected health information and gives individuals increased access to their medical records. It is the responsibility of those who create, maintain or distribute
protected health information (providers, insurance companies and clearinghouses) to safeguard this information. As the consumer, this law gives you certain rights and access to your information. These rights, and how to exercise them, are provided in the Notice of Privacy Practices (Privacy Notice) following this article. The Notice was initially printed in the Spring 2003 issue of Blue & You and we are required to notify members of the availability of the Notice once every three years. Paper copies of the Privacy Notice and the forms associated with making requests always are available through our Web sites or by calling your customer service representative. Members of self-funded group health plans served by BlueAdvantage Administrators of Arkansas, USAble Administrators or HMO Partners, please note: The following Privacy Notice does not apply to you because your plan will issue its own separate privacy notice. ❊
NOTICE OF PRIVACY PRACTICES 22
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
y law, Arkansas Blue Cross and Blue Shield and its afﬁliated companies (referred to for convenience as a group as “Arkansas Blue Cross”) is required to protect the privacy of your protected health information. We also must give you this notice to tell you how we may use and give out (“disclose”) your protected health information held by us. Throughout this notice we will use the name “Arkansas Blue Cross” as a short-hand reference for not only Arkansas Blue Cross and Blue Shield, but also for its afﬁliated company, HMO Partners, Inc., doing business as Health Advantage. Please note that although we are combining this privacy notice in this way for convenient, short-hand reference, and to make it more efﬁcient to inform you about your privacy rights, these companies remain separate companies, each with their own operations, management and compliance responsibilities. Arkansas Blue Cross must use and give out your protected health information to provide information: • To you or someone who has the legal right to act for you (your personal representative); • To the Secretary of the Department of Health and Human Services, if necessary to make sure your privacy is protected, and; • Where required by law. Arkansas Blue Cross has the right to use and give out your protected health information to pay for your health care and to perform business operations. For example:
Blue & You Spring 2006
• We can use your protected health information to pay or deny your claims, to collect your premiums or to share your beneﬁt payment with other insurer(s). • We can use your protected health information for regular health-care operations. Members of our staff may use information in your health record to assess our efﬁciency and outcomes in your case and others like it. This information then will be used in an effort to continually improve the quality and effectiveness of beneﬁts and services we provide. • We may disclose protected health information to your employer if your employer arranges for your insurance. If your employer meets the requirements outlined by the privacy law, we can disclose protected health information to the appropriate areas so they can modify beneﬁts, work to control overall plan costs, and improve service levels. This information may be in the form of routine reporting or special requests. • We may disclose to others who are contracted to provide services on our behalf. Some services are provided in our organization through contracts with others. Examples include pharmacy management programs, dental beneﬁts and a copy service we use when making copies of your health record. Our contracts require these business associates to appropriately protect your information. • Our health professionals and customer service representatives, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. An example would
be your spouse calling to verify a claim was paid, or the amount paid on a claim. Arkansas Blue Cross may use or give out your protected health information for the following purposes, under limited circumstances: • To state and other federal agencies that have the legal right to receive Arkansas Blue Cross data (such as to make sure we are making proper payments). • For public health activities (such as reporting disease outbreaks). • For government health-care oversight activities (such as fraud and abuse investigations). • For judicial and administrative proceedings (such as in response to a subpoena or other court order). • For law enforcement purposes (such as providing limited information to locate a missing person). • For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability). • To avoid a serious and imminent threat to health or safety. • To contact you regarding new or changed health-plan beneﬁts. By law, Arkansas Blue Cross must have your written permission (an “authorization”) to use or give out your protected health information for any purpose other than payment or health-care operations or other limited exceptions outlined here or in the Privacy regulation. You may take back (“revoke”) your written permission at any time, except if we already have acted based on your permission.
Your Rights Regarding Medical Information About You •
By law, you have the right to: See and get a copy of your protected health information that is contained in a designated record set that was used to make decisions about you. Have your protected health information amended if you believe that it is wrong, or if information is missing, and Arkansas Blue Cross agrees. If Arkansas Blue Cross disagrees, you may have a statement of your disagreement added to your protected health information. Receive a listing of those getting your protected health information from Arkansas Blue Cross. The listing will not cover your protected health information that was given out to you or your personal representative, that was given out for payment or health care operations, that was given out based on an authorization signed by you, or that was given out for law enforcement purposes. Ask Arkansas Blue Cross to communicate with you in a different manner or at a different place (for example, by sending your correspondence to a P.O. box instead of your home address) if you are in danger of personal harm if the information is not kept conﬁdential.
• Ask Arkansas Blue Cross to limit how your protected health information is used and given out to pay your claims and perform health-care operations. Please note that Arkansas Blue Cross may not be able to agree to your request. • Get a separate paper copy of this notice.
To Exercise Your Rights If you would like to contact Arkansas Blue Cross or Health Advantage for further information regarding this notice or exercise any of the rights described in this notice, you may do so by contacting Customer Service at the following telephone numbers: Toll Free Little Rock Arkansas Blue Cross (501) 378-2010 1-800-238-8379 Health Advantage (501) 378-2363 1-800-843-1329 You also may get complete instructions and request forms from the Arkansas Blue Cross or Health Advantage Web sites at: www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com
Changes to this Notice We are required by law to abide by the terms of this notice. We reserve the right to change this notice and make the revised or changed notice effective for medical information we already have about you as well as any future information we receive. When we make changes, we will notify you by sending a revised notice to the last known address we have for you. We also will post a copy of the current notice on the Arkansas Blue Cross and Health Advantage Web sites.
Complaints If you believe your privacy rights have been violated, you may ﬁle a complaint with Arkansas Blue Cross or one of its afﬁliated companies, or with the Secretary of the U.S. Department of Health and Human Services. You may ﬁle a complaint with Arkansas Blue Cross or one of its afﬁliated companies by writing to the following address: Privacy Ofﬁce ATTN: Privacy Ofﬁcer P.O. Box 3216 Little Rock, AR 72201 We will not penalize or in any other way retaliate against you for ﬁling a complaint with the Secretary or with us. You also may ﬁle a complaint with the Secretary of the U.S. Department of Health and Human Services. Complaints ﬁled directly with the Secretary must: (1) be in writing; (2) contain the name of the entity against which the complaint is lodged; (3) describe the relevant problems; and (4) be ﬁled within 180 days of the time you became or should have become aware of the problem.
Effective Date The provisions of this Notice became effective April 14, 2003.
❊ Blue & You Spring 2006
Blue & You Foundation
issues ﬁfth annual call for grant applications to support health programs
he Blue & You Foundation for a Healthier Arkansas has issued its ﬁfth annual call for grant applications to fund 2007 health programs, which support services to improve the health of Arkansans. The foundation, established in 2001 by Arkansas Blue Cross and Blue Shield, awards approximately $1 million in grants annually to nonproﬁt or governmental organizations and programs that positively affect the health of Arkansans. Particular emphasis is given to projects affecting health-care delivery, health-care policy and health-care economics. The deadline for applications is July 14, 2006. Information about applying for a grant is found on the foundation Web site at www.BlueAndYouFoundationArkansas.org, or may be requested by writing to Blue & You Foundation, Attention: Patrick O’Sullivan, USAble Corporate Center, 320 West Capitol, Suite 200, Little Rock, AR 72201. The grant applications will be reviewed in the fall and grants awarded in December for 2007 programs. “The poor health status of our citizens ranks 46th in the nation and contributes to rising medical costs,” said Patrick O’Sullivan, executive director of the foundation. “By providing funding and working together with other organizations, we hope to establish or expand a number of diverse health-care projects that will beneﬁt all Arkansans over the long term.” In its ﬁrst four years of operation, the Blue & You Foundation has awarded more than $4.8 million to 70 health improvement programs in Arkansas.
Patrick O’Sullivan (second from left), executive director of the Blue & You Foundation for a Healthier Arkansas, presents a $150,000 grant check to representatives of the Greater Texarkana People’s Clinic, including: (left to right) Gary Nutter, founding board member; Gloria Mugno RN, University of Arkansas Area Health Education Center; and Freddie Barber, interim executive director. The clinic provides medical care to the uninsured and underinsured residents of the Texarkana region.
Blue & You Spring 2006
Recipients of 2006 grants included Arkansas Children’s Hospital Foundation, Little Rock; Arkansas Educational Television Network (AETN) Foundation, Conway; Arkansas Delta Rural Development Network, Ozark Mountain Health, Clinton; Arkansas Foodbank Network, Inc., Little Rock; Arkansas Human Development Corporation, Little Rock; Christian Health Center, Camden; Coalition for Healthy Children, Jonesboro; Committee for Healthier Children/Beebe Public Schools, Beebe; Community Clinic at St. Francis House, Springdale; Conway County Christian Clinic, Morrilton; Crowley’s Ridge Rural Health Coalition, Paragould; Daughters of Charity Services of Arkansas, Dumas; Easter Seals Arkansas, Little Rock; Elkins Public Schools (Elementary), Elkins; Good Samaritan Clinic, Fort Smith; Greater Texarkana Peoples’ Clinic, Inc., Texarkana; Ozark Health Medical Center, Clinton; Parenting and Childbirth Education Services, Inc., Jonesboro; Safe Jonesboro Coalition, Jonesboro; Southeast Arkansas Health Foundation, Monticello; University of Arkansas for Medical Sciences/Helping Schools Help Themselves, Little Rock; University of Arkansas Division of Agriculture Cooperative Extension, Little Rock; and White River Rural Health Center, Inc., Augusta. The Blue & You Foundation and Arkansas Blue Cross are independent licensees of the Blue Cross and Blue Shield Association and serve the state of Arkansas. The foundation is a 501(c)3 organization.
Information for members of: Blue Cross and Blue Shield Service Beneﬁt Plan (Federal Employee Program) Blue Health Connection Blue Health Connection is your resource for around-the-clock health information. It is an added feature for your Blue Cross and Blue Shield Service Beneﬁt Plan (Federal Employee Program), and it puts you in touch with health professionals to help ensure your good health and that of your family.
Nurse Information Whenever you or a family member has a health-care question, anytime, day or night, registered nurses are available to assess your symptoms and provide health information. The nurses have a wide range of experience in emergency care, pediatrics and women’s health.
Call Us If you call Blue Health Connection toll free at 1-888-BLUE432 (1-888-2583432), a registered nurse will take the time to thoroughly assess your symptoms and concerns. The nurse also will help you make an informed decision about the most appropriate time and place for medical care should it be required. The nurse can give selfcare instructions to help you start feeling better while waiting for additional medical care that may be needed. If no further medical care is required, the nurse will call you back to check on you.
Contact Us Online You can connect to Blue Health Connection online at www. fepblue.org. You can e-mail the online counselors anytime a situation does not require an immediate response. For example, you may need some more information about a chronic condition or a test that a physician has scheduled. Using the online counselors
is a convenient resource for all of us who need a starting point to research a condition or procedure. If you think you are experiencing a life- or limb-threatening emergency, you always should call 911 or your local emergency service.
Health Information Library Blue Health Connection also offers many other types of resources. Online you can read the cover story, which changes weekly and highlights one speciﬁc topic or condition. The article incorporates various views about the topic from a reasoned analysis to practical suggestions and ideas. The online Condition Center provides indepth information about heart disease, heart failure, diabetes and asthma. The online Clinical Reference Systems (CRS) Advisor Series provides great information and illustrations about medical conditions, surgical procedures and medications written by health-care professionals. You also can access our audio library online, or you can call 1-888-BLUE-432 and press “2” to access the Audio Health Library. The information is available in English and Spanish. The Library has hundreds of topics, such as allergies, earaches, prenatal tests, acne, rashes and food poisoning. Blue Health Connection can be your personal resource for health information, whether it’s talking to a nurse on the telephone, e-mailing a nurse counselor or looking up information yourself.
❊ Source: Paula Spurway, Blue Cross and Blue Shield Association
Blue & You Spring 2006
Arkansas Blue Cross and Blue Shield family offers new and simple choices through Health Savings Administrators and The Vanguard Group for consumer-directed health plans
rkansas Blue Cross and Blue Shield and its family of companies is working with Health Savings Administrators and The Vanguard Group to offer new and simple choices within its Blue~by~design consumer-directed suite of health plans. The new Blue~by~design Health Savings Account (HSA) became available in January and offers 20 low-cost Vanguard equity index, active equity, balanced, bond and money market fund alternatives for participants. “Our Blue~by~design health plans for large and small employers are a response to a growing trend in the health insurance industry known as consumer-directed health care, which puts more decision-making ability in the hands of employees in regard to who provides their care and how it is paid for,” said Mike Brown, executive vice president for External Operations. “As we begin to integrate health-ﬁnancing services with investment services, it is very important that we work with strong companies like Health Savings Administrators and Vanguard to make the overall process easy, secure and ﬁnancially worthwhile for consumers.” Blue~by~design health plans were created to provide more choice for employees and more predictable costs for employers. Group plans are available. Unique to consumer-directed health plans are personal health accounts, which normally are funded by HSAs and Health Reimbursement Arrangements (HRAs). “We believe our Blue~by~design products offer tremendous beneﬁts to both employers and employees in the way of choice and control as well as helping them to understand health-care expenditures and make responsible health and ﬁnancial decisions,” said Brown. “Ultimately, we hope these innovative products lead to increased awareness of beneﬁts and cost, which may promote positive behavior changes and greater personal investment in health-care decisions.” In conjunction with the development of new consumer-directed health plans, Arkansas Blue Cross is designing an integrated information technology system that will bridge the gap between the health-care ﬁnancing and investment services industries.
Blue & You Spring 2006
“Arkansas Blue Cross, Vanguard and Health Savings Administrators all have strong histories of leveraging technology to serve their respective customers,” said Joseph Smith, senior vice president and chief information ofﬁcer of Arkansas Blue Cross. “This new system will help people manage new ﬁnancial accountabilities associated with HSAs, HRAs and Flexible Spending Accounts (FSAs) as well as simplify how they save for, select, and pay for health-care services.” Customers will continue working directly with Arkansas Blue Cross and its family of companies for Blue~by~design products. “Our goal is to coordinate products and help people simplify how they ﬁnance, educate themselves and make decisions about their health care,” said Steve Abell, vice president of Enterprise Networks. “This new relationship with Health Savings Administrators and Vanguard represents our ﬁrst step into fully integrating health products with ﬁnancial services to simplify the process for our customers.” The Vanguard Group, headquartered in Valley Forge, Pa., is the nation’s second-largest mutual fund ﬁrm and a leading provider of company-sponsored retirement plan services. Vanguard manages more than $895 billion in U.S. mutual fund assets, including more than $260 billion in employer-sponsored retirement plans. Vanguard offers 130 funds to U.S. investors and more than 40 additional funds in foreign markets. Health Savings Administrators was originally formed as Medical Savings Administrators in 1997 and was one of the ﬁrst to offer HSAs when the legislation changed in 2004. Located in Richmond, Va., Health Savings Administrators specializes in offering no-load mutual funds to HSA account holders nationwide, thus allowing customers to avoid the high cost of commissions on investment choices. ❊
Blue & You readers value magazine, appreciate Internet services Readership Survey Results: Members use, appreciate health topics
ccording to our annual Blue & You readership survey, the dedication of Arkansas Blue Cross and Blue Shield (and afﬁliated companies) to provide members with in-depth healthand-wellness information is needed and appreciated by our members. Blue & You readers sent a clear message that they use the health information provided in Blue & You and have changed their lifestyles due to information found in Blue & You. The Autumn 2005 issue had a readership survey enclosed for members to return with comments, and members gave Blue & You an average of 4.55 on a ﬁve-point scale (with ﬁve being the highest rating) in the “Value” category. Survey respondents gave Blue & You a mean satisfaction rate of 4.59 in the “Helpful” category and a 4.59 in the “Attractive” category. All scores reﬂected increases when compared to scores from 2004. For the third year in a row, we asked an additional question to our members, which required a simple “yes” or “no” response. The question was, “Have you made a healthy change in your behavior because of something you’ve read in Blue & You?” A total of 85 percent of survey respondents answered “yes” to that question. That’s an increase of 4 percent when compared to the 2004 survey. Of the 630 survey respondents, 324 took time to write additional comments, and of those, 99 percent were positive. Comments included: • “I love Blue & You. I save every copy. Sometimes refer back to them. Very helpful.” • “Arkansas Blue Cross and Blue Shield is providing a great service to the state of Arkansas.” • “I appreciate the information given in each issue. I believe it should be published monthly instead of quarterly. Thanks!” • “Interesting articles about diseases and symptoms. Also, liked the report on generic drugs and tests with radiation exposure.” • “This has been the most helpful magazine to me because it addresses issues not just introduces them.” • “I am learning more music. An active mind is a healthy mind. Started reading more. I will take up dance lessons, foreign language (Spanish); taking care of my skin and vision health helpful. I’m looking for a part-time job. Helpful.” • “It’s the best I ever had. No other can match it.” • “This magazine is very helpful. It has replaced other health magazines that I once ordered.” • “Very helpful medical articles in every magazine. I read it
• • •
cover to cover and most of the time, take notes. I am a retired university professor and always take notes on important issues.” “I have read through it. I have changed my eating habits and exercise. Thanks.” “An excellent source of information.” “The magazine is helping me stay independent. The facts on nutritional foods, exercise and risk factors. I’m 84 years old and live by myself.” “I ﬁnd a lot of information which I am not able to get anywhere else.” “I really enjoy reading this magazine. The article on long-term care (LTC) insurance (BlueSecure) was very helpful as I had received a letter from my employer concerning LTC insurance.”
Web Survey Results Our members’ awareness of ArkansasBlueCross.com, HealthAdvantage-hmo.com and BlueAdvantageArkansas.com continued to improve with the annual Internet survey included in the autumn 2005 issue of Blue & You. Only 19.5 percent were not aware of the sites, compared to 56 percent in 2001, the ﬁrst year the survey was done. About 67 percent of those who visited the Web sites during 2005 found them useful. They gave the sites a rating of 4 or 5 on a ﬁve-point scale. The total number of respondents with Internet access decreased from 70 percent in 2004 to 65 percent in 2005, but this could be a result of the decrease in the number of respondents (300 compared to 465 last year). Of those with Internet access, 46 percent had broadband (fast) service. The features respondents found most useful were “Provider Directory” (63 respondents) My Blueprint (47 respondents) and “Health Plans & Services” (41 respondents). The three top features members said they would like to see on the sites were: 1. Review beneﬁts (95 respondents) 2. Health-and-wellness information (83 respondents) 3. Out-of-pocket accumulation (44 respondents) Beneﬁt summaries now are available for BlueAdvantage and Health Advantage members and coming soon for Arkansas Blue Cross members. Health-and-wellness information (Healthwise® Knowledgebase) is online now through My Blueprint. Outof-pocket accumulation is available through My Blueprint for BlueAdvantage members and coming soon for Health Advantage and Arkansas Blue Cross members.
Survey, continued on Page 32
Blue & You Spring 2006
Multi-source Ortho products no longer covered Effective Jan. 1, 2006, the following brand-name oral contraceptives are no longer covered: Ortho-Tri-Cyclen
Generic equivalents of the brands above will be covered. The following oral contraceptives listed below are covered on the 2006 Oral Contraceptive Formulary. First Tier
All Generic Oral Contraceptives
Ortho-Evra Patch Ortho-Tricyclen-LO Seasonale (3-copays)
ou could be guilty of healthcare fraud if you don’t remove your ex-spouse from your healthinsurance policy. As the contract holder, if your divorced spouse (ex-spouse) or other ineligible dependent is listed on your health-insurance policy as a dependent, you are ﬁnancially responsible for any claims that are paid in error by Arkansas Blue Cross and Blue Shield or Health Advantage. And that’s not all. Your insurance coverage will be canceled and you could lose your job if you are covered under a group policy.
Other dependents that are ineligible for coverage under your contract include your boyfriend, girlfriend, grandchildren or adult children. Each policy may be different, so check your Certiﬁcate of Coverage or call Customer Service (telephone numbers are listed on Page 3) if you are unsure about the coverage for your children or others. Be a fraud buster! Call the fraud hotline day or night at 1-800FRAUD21 (1-800-372-8321). All tips are kept strictly conﬁdential.
Coverage information for the Aerochamber
n Aerochamber, usually used by young children, handicapped children or the elderly, is a device used to assist in the administration of bronchial inhalers. It is not covered under the pharmacy beneﬁts if you are a Health Advantage, BlueAdvantage
Administrators of Arkansas or regular Arkansas Blue Cross and Blue Shield member. Most durable medical suppliers carry these. When you pick up the inhaler at the pharmacy, the Aerochamber does not come with the medicine. It must be purchased separately.
❊ Blue & You Spring 2006
“One Class at a Time” grants continue to help teachers
o date, BlueAnn Ewe and Fox 16 News at Nine have awarded $500 grants to nine deserving teachers in Arkansas. The newest winners are: Dwight Kelley — Jacksonville Middle School for Boys — to purchase a camcorder to be used by students as they study hurricanes, prepare reports and present their information on camera as a newscast for use as a teaching tool. Cindy Whitaker – Brookland High School — to support the Brookland EAST program in its efforts to teach elementary schoolaged students (K-3) about health and ﬁtness through a health fair and “healthy competition.”
As a reminder each month, FOX 16 News at Nine and Arkansas Blue Cross will award a $500 grant to a teacher/classroom around the state of Arkansas to help supplement class needs. Teachers in need of supplies, classroom tools, ﬁeld trips, books, computers or other educational necessities can go online to www.FOX16.com and apply for a grant. BlueAnn and FOX 16 news personalities travel monthly to a school to award a grant to the winning teacher. That award will be ﬁlmed and shown on FOX 16 News at Nine. The winners also will be posted on the Web sites. For more information, visit BlueAnn’s Web site or the FOX 16 Web site. ❊ BlueAnn poses with Fred Burnett and B.L.A.S.T. students at Bryant High School during the “One Class at a Time” grant award presentation.
Fred Burnett – Bryant High School – to provide wireless Internet networking capabilities for the B.L.A.S.T. (Bringing Learning Around Schools with Technology) program. High School students are converting an old school bus into a mobile computer lab to take to elementary schools and community centers in the area. Tonya Thacker – Mena Middle School – to provide rewards and recognition for almost 200 eighth-graders participating in the school’s abstinence program, which teaches them the consequences of high-risk behaviors such as drinking, drugs, smoking and pre-marital sex.
Blue & You is archived as your Web site “library”
eginning with the Autumn 1999 issue of Blue & You, Arkansas Blue Cross and Blue Shield has made all issues of Blue & You available on our Web sites in the “Members” sections on www. ArkansasBlueCross.com, www.HealthAdvantage-hmo.com and www.BlueAdvantageArkansas.com. To help you ﬁnd the health information you are looking for, following is a list of the date of the publication and the health topic covered in each issue.*
2002 Spring — Digestive Health Summer — Taking Care of Your Skin Autumn — Autoimmune Diseases Winter — Making Healthy Choices
1999 Autumn — Women’s Health Winter — Heart Health
2003 Spring — Brand Name vs. Generic Drugs Summer — Summer Health Issues Autumn — Allergies Winter — Taking Responsibility for Your Health
2000 Spring — Children’s Health Summer — Senior Health Autumn — Men’s Health Winter — Wellness
2004 Spring — Brain & Nervous System Summer — How Healthy Is Your Teen? Autumn — Your Health: What the Numbers Mean Winter — The Obesity Crisis
2001 Spring — Nutrition Summer — Safety Issues Autumn — Cancer Winter — Respiratory Care
2005 Spring — Arkansas’ Big Six: Are You at Risk? Summer — Keeping Kids Healthy Autumn — Super Seniors: Aging Well in America Winter — Contagious Diseases ❊
Past issues of Blue & You may be reviewed on our Web sites.
* Information in past issues may not reﬂect updates since publication. Blue & You Spring 2006
Richard Leithiser, M.D., M.M.M., named associate medical director at Arkansas Blue Cross
ichard Leithiser, M.D., M.M.M., a radiologist, has been named associate medical director for Arkansas Blue Cross and Blue Shield. Leithiser has 25 years of clinical experience in diagnostic radiology and 10 years of experience in hospital administration and medical management. In addition, he has extensive experience in billing, coding and provider credentialing, and federal and state regulatory standards. Prior to joining Arkansas Blue Cross, he was in practice and on the teaching faculty of the University of Arkansas for Medical Sciences (UAMS) and the Medical University of South Carolina Department of Radiology. He served as chief of staff at Arkansas Children’s Hospital (ACH) in Little Rock from 1998 to 2000 and chief of Pediatric Radiology at ACH from 2000 to 2005. Leithiser has served as president of the Children’s Healthcare Systems, Inc. board of directors and on the ACH board of directors (ﬁnance, executive and quality and service committees). A native of Maryland, Leithiser received his bachelor’s degree from and completed post-graduate work at Wake Forest University in North Carolina and received his medical degree from Bowman Gray School of Medicine at Wake Forest. Leithiser
completed his internship in internal medicine from Strong Memorial Hospital in Rochester, N.Y., and his residency in diagnostic radiology at Rochester General Hospital in New York. He completed a fellowship in pediatric radiology at St. Christopher’s Hospital for Children in Philadelphia in 1984. Leithiser completed his master’s degree in medical management from Tulane University in New Orleans. Leithiser is certiﬁed in diagnostic radiology with the American Board of Radiology, certiﬁed with added qualiﬁcations in pediatric radiology by the American Board of Radiology, and is a certiﬁed professional coder with the American Academy of Professional Coders. ❊
Arkansas Blue Cross announces leadership changes
ecently, several promotions and leadership changes were made at Arkansas Blue Cross and Blue Shield to help position it and its family of companies for the future. David Bridges, who has been serving as the president and chief executive ofﬁcer of Health Advantage and senior vice president of Arkansas Blue Cross Customer Services, has been promoted to executive vice president of Internal Operations and will continue as president and CEO of Health Advantage. Bridges Mike Brown, who has served as senior vice president of Enterprise Networks, has been promoted to executive vice president of External Operations. In addition Ron DeBerry, vice president of Statewide Business; Joseph S. Smith, vice Brown president of Private Programs and chief information ofﬁcer; and Sam Partin, vice president of Actuarial and Risk Management, all have been promoted to senior vice president for their respective divisions. Steve Abell, former regional executive for the West Central Region, was named vice president of Enterprise Networks and assumes responsibility for Medical Audit and Review, Enterprise Medical Management, Health Care Information Services, Provider
Blue & You Spring 2006
Network Operations, Hospital Reimbursement and Pricing, and Pharmacy Operations. Kathy Ryan has been promoted to vice president of Health Advantage Operations, which includes the Health Advantage divisions of Customer Service, Claims, Information Systems and Customer Accounts. Patrick O’Sullivan was named to lead the Blue & You Foundation for a Healthier Arkansas in the newly created position of executive director. O’Sullivan will focus on the growth of the Foundation with regard to direction, visibility and successful program development. The Blue & You Foundation now awards grants totaling more than $1 million annually. Karen Raley, former regional executive for the Southeast Regional Ofﬁce, has been named vice president of Communications and Product Development. She will assume the executive leadership role for Advertising & Communications, Product Development and Marketing Support. “Great leadership has helped make our family of companies strong and stable in an ever-changing health-care market,” said Sharon Allen, president and chief operating ofﬁcer of Arkansas Blue Cross. “We believe the experience and skills of our leadership team will continue to position us to provide quality, innovative health-care ﬁnancing solutions for our members for many years to come.” ❊
Blue & Your Community A
rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans.
All’s fair in Rison Rochelle Nix of the Southeast Regional Ofﬁce in Pine Bluff and BlueAnn Ewe participated in the Cleveland County Health Expo in Rison. BlueAnn played toss the football with the children for a chance to win Nerf® footballs and jump ropes. Any child that played received an apple, orange or banana. Parents also could enroll their kids in the BlueAnn Health Club. Parents could pick information on the Resp-A-CHOO Survival Guide at our booth as well. Other booths at the fair offered prostate screenings, mammograms, blood sugar, vision and hearing screenings.
Family festival time BlueAnn Ewe was a special guest at the St. Theresa’s Church family festival in Southwest Little Rock. BlueAnn greeted kids and parents as they participated in a dinosaur bone dig, face painting, dunking booth, ﬁsh pond, soccer kick, pop-cork target practice, cake walk, basketball shoot and more. Hundreds of folks turned out for the event.
MARS plays Santa in Morrilton Arkansas Blue Cross and Blue Shield’s Medical Audit and Review Services (MARS) division helped make Christmas happy … and blue … in 2005. The team donated ﬁve bags of games and a DVD player to the children at Southern Christian Home in Morrilton. Gina Wirt, Iris McGee, Catherine Whitﬁeld, Chiquita Kids at Southern Christian Home in Morrilton welcome MARS and BlueAnn.
Briscoe and Kathy Tanner helped organize the effort. All the folks in MARS raised money to help buy the gifts.
Costumes and creative reading Members of the Northwest Regional Ofﬁce staff recently participated in the Fayetteville Public Library’s Reading Rally. BlueAnn Ewe and the Cat in the Hat were special guests at the event and guest readers for the day included Fayetteville Mayor Dan Coody and Arkansas Razorback football players. Children in attendance got to hear lots of great stories read aloud, enjoy cookies and lemonade, receive goody bags and participate in creating a craft. Magicians Impossible presented a magic show and children also participated in a costume parade for a chance to win prizes. ❊ Young readers participate in the costume parade at the Fayetteville Public Library’s Reading Rally.
Blue & You Spring 2006
Blue Web sites getting a makeover If you have visited BlueAdvantageArkansas.com recently, you might have noticed a fresh, new design. The new design will appear on HealthAdvantage-hmo.com this month and ArkansasBlueCross.com soon after. This redesign has two purposes. The ﬁrst is to serve you better by making the sites easier to use while providing you with the information you need to manage your health-beneﬁt plans. The other purpose is to keep the sites up to date by taking advantage of design innovations and technological advances. In conjunction with the new look and feel, the code behind the scenes has been rewritten. The basic structure of the sites has not changed, but navigation has been enhanced: • The major section links are easier to ﬁnd. They are at the top left of the home page and in the left navigation bar of all internal pages. Survey, continued from Page 27 “I would like to see more members responding to our Web survey,” said Karen Raley, vice president of Communications and Product Development for Arkansas Blue Cross. “The annual survey results help guide Web site development to make the sites more useful and beneﬁcial to members. We really take their responses seriously and welcome any suggestions they have for improving the sites.” Watch for your chance to inﬂuence Web site content in fall 2006. A survey card will be included in that issue of Blue & You.
Gift card winners! From the Blue & You readership survey, we randomly selected three winners, who each received a $50 Wal-Mart gift card. The winners were Ann Sullivant of Hot Springs, Linda Christie of Pangburn and Lindell Blount of Delight. From the Web survey, we also randomly selected three winners who each received a $50 Wal-Mart gift card. The winners were Roger Newman of El Dorado, Ednarene Rodgers of Little Rock and Sandra Heston of Mountain Home. ❊
Online • The audience links (guests, members, employers, providers) also are located at the top of the home page and at the top of all internal pages. • “Quick Links” on the home page provide easy, one-click access to popular sections that are not main-menu items. • A new self-service center on the home page allows registered members to log in to My Blueprint and My Tracker without going deeper in the site. • “Search” is accessible from any page of the site. The “Search” box appears in the top bar. Members’ suggestions for improving the Web sites are important. To send a comment, go to the “Contact Us” section and click on the “E-Mail Webmaster” link. On the BlueAdvantage site, that link is near the bottom of the page. ❊
www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181
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